<!DOCTYPE html>
<html>

	<head>
		<meta charset="utf-8" />
		<title></title>
		<meta name="viewport" content="width=device-width, initial-scale=1,maximum-scale=1,user-scalable=no">
		<script src="../../js/jquery-2.1.4.min.js"></script>
		<script type="text/javascript" src="../../js/common.js"></script>
		<script src="index.js"></script>
		<link rel="stylesheet" type="text/css" href="../../css/common.css" />
		<link rel="stylesheet" type="text/css" href="index.css" />
		<script src="../../laydate/laydate.js"></script>
	</head>

	<body>
		<div class="contiler ">
			<div class="header ">
				<div class="nav-bar ">
					<div class="nav-bar-left ">
						<a class="xiaoyuhao ">
							<i class="iconfont icon-xiaoyuhao "></i>
						</a>
					</div>
					<div class="nav-bar-title ">我要报备</div>
					<div class="nav-bar-right ">
					</div>
				</div>
			</div>
			<div class="contentx">

				<div class="item ">
					<span>姓名:</span>
					<input type="text " name="name " id="name" value=""></input>
				</div>
				<div class="item ">
					<span>电话:</span>
					<input type="text " name="phone" id="phone" value="" maxlength="11"></input>
				</div>
				<div class="item ">
					<span>备用电话:</span>
					<input type="text " name="standbyPhone" id="standbyPhone" value="" maxlength="11"></input>
				</div>
				<div class="item">
					<span>报备留言:</span> 
					<textarea class="build-name"  rows="5" cols="30" id="words"></textarea>
				</div>
				<div class="item">
					<span>意向楼盘:</span>
					<select name="loupan" id="loupan">
						<option value="">请选择</option>
					</select>
				</div>
				<div class="item ">
					<span>购房意向:</span>
					<select name="goufang" id="goufang">
						
					</select>
				</div>
				<div class="item ">
					<span>置业顾问:</span>
					<select name="guwen" id="guwen">					
					</select>
				</div>
			</div>
			<div class="lg-sub">
				<input id="lg-sub-s" type="submit" value="报备" class="lg-sbt">
			</div>

	</body>

</html>